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❑ New ❑ Addition [ Remodel <br /> ❑ Replace <br /> Site Address: <br /> Owner: (� (.f �(,� Mailing ddress: <br /> City: �� Zip: <br /> Home Phone: Q Alternate Phone: <br /> a <br /> 3pContractor/App.: _ Contact Person: <br /> Address: 9L f State License#: <br /> City: S-P-12--Ld Zip: r 1 Expiration Date: 1,0 <br /> Phone: LY✓( G - Alternate Phone: <br /> M 4 <br /> 777 ,77 , <br /> a <br /> )Commercial-Fire Sprinkler ❑ Residential-Fire S nnkler <br /> Fire Systems Permit Fire Systems Permit <br /> *Base Price=Contract Price: x_.0125 =$ "% i (Minimum$35.00) <br /> *Surcharge=Contract Price:$ X.0005 =$ r (Minimum $ .50) <br /> *Mail-In Fee(Only On Mail In Applicath'ons) =$ 1.50 <br /> *Total Cost of Permit: <br /> The undersigned herby applies to the City for�suance of a Sprinkler Systems Permit. Applicant agrees <br /> that all systems shall be designed, installed anmaintained to N.F.P.A.-13,N.F.P.A.-25,Minnesota State <br /> Building Code,Minnesota State Fire Code an4 Standards,and certifies that all statements made on this <br /> lication are complete,true anal correct. j <br /> Applicant Date <br />